Mise en récit de la souffrance de patients par des médecins généralistes

Psychic suffering is an underlying motive in many general medical consultations. General practitioners have no specific training to treat this suffering, and must develop practical knowledge, based on experience. Although they say they are simply “receptacles” for the complaints expressed, and lacking analytical tools, the doctors in four focus groups we have studied nonetheless practiced “active listening” which sometimes proves to be the best form of care. But without analytical tools, communicating this experience in the group can only take the form of a narrative account. The narrative sequences constructed around various patients have been selected for analysis according to the Greimassien actancial model. Narrative series evoke extreme manifestations of psychic suffering, from tears to suicide. Both narrator and actor, the general practitioner at times represents him/herself as a Subject capable of and wanting to respond to the patient's call for care, and sometimes as an agent contributing to the acquisition of the Object (care), when the patient is the Subject. While the place of the doctor-Subject can change in the accounts analyzed, it is only when the patient-Destinators are outside of reality that the doctor disappears from the axis of desire. In this model the ideal treatment - Object of desire of the doctor-Subject - is only ideal insofar as it fulfils the implicit expectations of the suffering patient, who is an actor in the process set in motion by the doctor, insofar as the latter is willing to be mobilized. At this point comes into play the practical knowledge that the doctors in our study possess, almost without being aware of it.